Dorothea Dix unit closes

RALEIGH
Chris Marsh’s sister has been in and out of the mental health system ever since she was diagnosed with schizophrenia and bipolar disorder in her 20s. Two years ago, she was admitted to the Female Continuing Care unit at Dorothea Dix Hospital, a psychiatric hospital in Raleigh. A few weeks ago, Marsh thought her treatment would go on forever.

“Because she goes in and out of hospitals so much, the care she got (at Dix) was exceptional because Dr. Wells projects such a positive image in terms of his expectations that you will get well,” Marsh said.

Now, Marsh is hoping that his sister will be transferred into a group home instead of to another hospital

But things are uncertain for six remaining patients under the care of Dr. James’ Wells, the attending psychiatrist at the Female Continuing Care unit.

The unit’s closing on Monday comes more than a month before the entire mental health hospital will be effectively shut down, with the exception of 30 beds devoted to previously criminal patients and two outpatient units.

N.C. Department of Health and Human Services Secretary Lanier Cansler ordered the hospital to close on December 23. Legislators hope closing Dix will save $16.9 million for the state, but that figure is overshadowed by the state’s $3-to-4 billion budget shortfall.

“Our unit will be done as for tomorrow afternoon,” Wells lamented in an interview on Sunday. “We’ve turned a dysfunctional unit into a highly effective unit and it’s gonna be gone, and that’s kind of sad.”

The Female Continuing Care unit specializes in treating patients who have had multiple hospitalizations. One patient had 87 previous hospital admissions and hundreds of emergency room visits. He said that most patients came to the unit despondent and doubtful that they’d ever be successfully treated.

Many Dix staff members have job offers at the state’s remaining hospitals. The majority of the staff from the Female Continuing Care unit has already been transferred to Dix’s modern replacement, Central Regional Hospital in Butner. The rest were transferred Monday, leaving Wells and one social worker to oversee the transfer of the remaining six patients to Central Regional and Cherry Hospital in Goldsboro, two of the three remaining state psychiatric facilities as of December.

Staff transferred two patients to Cherry on Monday and another two patients will relocate to Cherry on Wednesday. Wells said one of his patients is refusing to go to Cherry because she’s worried that her daughter and guardian won’t be able to make the long trip from Durham to visit her. If she refuses care at Cherry she’d likely be transferred to Central Regional, which could be unwise because she has had past altercations there, resulting in a lawsuit against the state, he said.

Until they’re transferred off-site, patients will be relocated to an acute admissions unit at Dix. Wells is worried that the transition could be rocky for those left behind. Although he voiced his concerns to his superiors, he said no one has taken action.

“In my opinion, it’s not a good idea to mix patients in different units,” Wells said. “But they are not willing to listen to us. So those four patients will be transferred to the best situation that we can sort of figure out.”

Patients in the continuing care ward had certain privileges that acute care patients don’t, like being allowed to smoke. Wells asked his patients to be respectful and discrete about smoking while they’re being relocated.

“I think it’s hard for a person to move from an environment that feels safe,” said N.C. Rep. Verla Insko, D-N.C., a member of the mental health oversight committee. “It’s a setback to their health.”

Insko admits she’s worried that the transfer could disrupt patient care, but she’s adamant that closing Dix is the right thing to.

Wells was previously notified this would be his last week at the hospital, despite his request for more time to ensure a smoother transition for the remaining patients. He said a stipulation in his contract allowed him to stay through early December. He hopes the time will allow him to continue to work with his patients until the hospital closes.

Turning around the continuing care unit

When Wells joined the unit in 2008, he said even staff members were skeptical about their abilities to improve the patients’ conditions. Wells compared the unit to a train station — noisy and chaotic. Patients routinely tore water fountains off of walls and broke glass at the nurse’s station.

But Wells met these negative attitudes with empathy. He said listening to patients and validating their concerns were key to the unit’s turnaround.

“If there’s no reason to say no, then don’t,” he said. “If there is a reason to say no, say no but then explain why. You’re talking to them in a fashion that doesn’t give them the sense that they don’t have any options. I think that’s one of the hallmarks of what we’ve done with continuing care.”

Patients were also allowed to have their own CD players, and they could select their favorite music to play on the devices. It might seem like a small allowance, but it was helpful in calming tensions in the unit, Wells said.

“We would allow people to have as much freedom as they can in the context of being in the hospital,” he said.

Violence in the unit decreased dramatically, he said. When the unit closed, it had been more than 20 months since a patient had been restrained.

After his sister’s two-year stay at Dix, Marsh is hoping she will be able to move into a group home soon. But his sister’s illness has made him realize there’s always the danger of relapsing.

“That’s part of what it is,” Marsh said. “It’s like sending someone off to college or anything else. You can’t think that way because then you’ve defeated yourself.”

Losing the fight to keep Dix open

Wells opposed Dix’s closing as soon as it was announced. He warns that closing the hospital could bring back some of the same conditions that Dorothea Dix railed against during her first visit to the state in 1848, such as the conditions the mentally ill faced in state prisons.

In October, he sent a detailed letter about the consequences of closing the hospital to legislators. The mentally ill face relapse, longer waits in emergency rooms and inadequate care that could result in lawsuits, he wrote. All of this could be costlier to taxpayers than keeping the hospital open.

Wells said the cost of keeping Dix open is a drop in the bucket compared to the state’s budget shortfall. But the costs and savings of keeping Dix open are foremost on the minds of legislators.

“The money’s just not there,” Insko said. “If we had the money we would probably keep it open for another two years. I agree that our budget shortfall is a huge problem, but we would be making it $16 million worse.”

Wells has heard these arguments but he doesn’t believe that the hospital’s closing rests solely on financing.

“I think if I gave them 16 million dollars, they would hem and haw and think of some reason why they couldn’t do it,” he said.

While Wells said he is skeptical about the state’s real reasons for shutting down Dix, he knows it can only be saved by the last-minute actions of legislators like Insko. Last week, Wells invited Insko to tour Dix. He notified the hospital director, Dr. James Osberg, just before Insko arrived.

Osberg stopped the tour but allowed staff members to voice their concerns to Insko in a conference room. Insko said she didn’t meet or talk to any patients while she was at the hospital.

Wells said staff members at Dix are worried about the closing. One custodian worried that she wouldn’t be able to make the trip to Central Regional. Wells said if she doesn’t show up before a specified date, her employers will assume that she’s resigned and she won’t receive benefits.

“Nothing has been done to help these people,” he said. “Nothing in terms of transportation costs or severance pay.”

Wells and Insko have been friends for many years. He’s has also been a political supporter of hers but said he’s disappointed that she hasn’t spoken out against the hospital’s closing.

But Insko hasn’t spoken out against closing the hospital because it’s the right thing to do, she said. Dix and Central Regional are located 34 miles apart, and Insko said it doesn’t make sense that two major mental health hospitals should be located so close to each other. She favors serving the state’s mentally ill with only three hospitals.

She is also concerned about Wells’ assertions that Dix patients won’t get the same quality of care at other state hospitals.

“Why are we just now learning that Dix has better services?” Insko said. “And why don’t we know about that as legislators?”

Despite Wells’ assertions that closing Dix will turn the clock back on mental health in North Carolina, Insko sees it as an opportunity to improve the quality of care at the three remaining hospitals. The state shouldn’t have one hospital that is better than another, Isnko said.

She would also like to see more emphasis placed on treating patients on the local level. Insko said it’s better for patients and their families if they’re treated at community group homes like the one in which Chris Marsh is hoping his sister will be placed.